title: Cerebral magnetic resonance imaging findings in adults with haemolytic uraemic syndrome following an infection with Escherichia coli, subtype O104:H4.
abstract: OBJECTIVE
  Infections with Enterohaemorrhagic Escherichia coli typically occur in children causing haemolytic uraemic syndrome (HUS) and neurological symptoms in 20-50 %. Little information is available on the morphology of brain manifestations in adults. The purpose of this study was to identify a characteristic magnetic resonance imaging (MRI) pattern during the outbreak of a novel mutation of Escherichia coli O104:H4.
  
  
  METHODS
  Patients were recruited from two hospitals between May and July 2011. The MRI protocol included standard anatomical, diffusion-weighted, and susceptibility-sensitive sequences.
  
  
  RESULTS
  A total of 104 MRIs of 57 (32 female, 25 male) patients (mean 45.5 ± 18.4 years) showed abnormal signal intensity on 51 MRIs (49 %). Bilateral thalamus (39 %), bilateral pons (35 %), centrum semiovale and splenium of corpus callosum (33 %) were most often involved. Acute lesions were reversible in 81 % of cases. There was no statistically significant association between symptom onset and the MRI findings (P = 0.2).
  
  
  CONCLUSIONS
  Neuroimaging findings in this adult patient cohort were non-specific and similar to previous findings in children. A characteristic neuroimaging pattern of an infection with Escherichia coli O104:H4 was not identified. However, bilateral symmetric T2 hyperintense lesions of the thalami and dorsal pons characterized by restricted diffusion suggest a metabolic toxic effect of the disease on the brain.
authors.affiliation: Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany, fiehler@uke.de.
authors.forename: U
authors.initials: U
authors.lastname: Löbel
authors.forename: B
authors.initials: B
authors.lastname: Eckert
authors.forename: O
authors.initials: O
authors.lastname: Simova
authors.forename: M
authors.initials: M
authors.lastname: Meier-Cillien
authors.forename: S
authors.initials: S
authors.lastname: Kluge
authors.forename: C
authors.initials: C
authors.lastname: Gerloff
authors.forename: J
authors.initials: J
authors.lastname: Röther
authors.forename: T
authors.initials: T
authors.lastname: Magnus
authors.forename: J
authors.initials: J
authors.lastname: Fiehler
mesh_terms: D001921:Brain / Q000382:microbiology / Q000473:pathology; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D004660:Encephalitis / Q000150:complications / Q000382:microbiology / Q000473:pathology*; D054324:Enterohemorrhagic Escherichia coli; D004927:Escherichia coli Infections / Q000150:complications / Q000382:microbiology / Q000473:pathology*; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000209:etiology / Q000382:microbiology / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity